For as long as I’ve been treating anxiety, I’ve had patients using cannabis. Some recreationally, some because they find that it helps them with sleep, social situations, anxiety or just to calm down. Sometimes their health goals involve using less cannabis, sometimes not. With recreational cannabis legal in Canada - I’ve noticed more of my patients disclosing their cannabis use, and asking for my thoughts.

It’s a complicated topic, one I’ve thought about a lot and done a lot of research on. Seriously, it took me almost 6 months to write this article. What I’m going to share is based the research on recreational cannabis use and anxiety.

I’m hoping that it’s obvious, but just to be clear, reading something on the internet does not constitute medical advice. If you are interested in medical use of cannabis you should speak to a medical doctor who prescribes medical cannabis.

So with that out of the way here is what I’ve learned:

People Suffering from Anxiety Disorders Use More Cannabis

A survey on recreational cannabis use showed higher levels of use in people with pre-existing anxiety conditions(1). First, individuals with anxiety used more cannabis at a time, and because of this had higher levels of “acute anxiety responses” to cannabis (so they were more likely to get anxiety from using cannabis(1)).

Also, individuals with anxiety who identified as self-medicating with cannabis were using it more frequently (1).

CBD Is A Potential Treatment For Anxiety Disorders

With all these people with anxiety using cannabis, a natural question is does it work to treat anxiety?

The answer, at this point, is that the Cannabidoil, also called CBD, might. There is a lot of what’s called “preclinical evidence” that CBD may be helpful in a variety of anxiety disorders and disorders related to anxiety such as Generalized Anxiety Disorder, Panic Disorder, Social Anxiety Disorder, Obsessive Compulsive Disorder, and Post-Traumatic Stress Disorder (2).

This means that when you look at how CBD acts in the brain, how anxiety effects the brain and how mice respond to CBD and stress, it seems like CBD might be helpful.

The problem is that people are not mice and while there has been some research in Social Anxiety (3) and PTSD(4) and there has not yet been a lot of research in humans.

But it’s not all benefits when it comes to Cannabis and Anxiety in fact…

Anxiety is a Side Effect of Cannabis(5)

Yes, you read that right. While there is evidence that CBD might help with anxiety, there is also evidence of cannabis causing anxiety. Particularly in higher amounts, cannabis has been shown to cause episodes of aggravated anxiety and panic attacks(6,7). Not Fun.

The long term effects of cannabis and anxiety are a bit harder to tease out because it’s all based on reporting but we do know that individuals who use cannabis over the long term have higher rates of anxiety disorders, affective disorders and psychosis(6,7), particularly younger people(8).

Cannabis and Psychosis

There is a lot of research linking cannabis as a risk factor for psychosis (9,10). Unfortunately this strong association is a little challenging to understand. There has not yet been a strong biological link identified (11) and some researchers are concluding that cannabis does not cause psychosis but that early and heavy use of cannabis are more likely in people who are vulnerable to developing psychosis (12). Whether this is also true for the link in developing anxiety disorders remains to be seen (5).

While this was thought to be related to the TCH and not the CBD portion of cannabis, there is a report of a patient using CBD strains prior to the onset of their psychosis (13). Whether or not the strains were adulterated or mislabeled is not known.

At the end of the day there are lots of great herbs for treating anxiety